If you’ve never felt a twinge of pain in your knee and wondered whether a knee replacement was in your future, you’re one of very few older adults. Fortunately for UMRA members, Elizabeth Arendt, MD, professor and vice chair of the U of M’s Department of Orthopedic Surgery, generously shared some of her expertise in diseases of the knee for our February Living Well workshop. Arendt was inducted into the Sports Medicine Hall of Fame in 2022 and has received numerous other awards and recognitions.

View a video recording of UMRA’s February 2024 workshop with Elizabeth Arendt, MD.

Warm-ups and slow stretching become increasingly important as we age, Arendt noted. Strengthening muscles around the knee and using good form are key to avoiding overuse injuries. Using nonsteroidal anti-inflammatory drugs, or NSAIDs, such as Motrin and Aleve after muscle strains is controversial (and pose a risk for anyone taking a blood thinner), and recommended only for major pain. Stick with acetaminophen (e.g., Tylenol) if possible. 

Common causes of knee pain include tendonitis (now called tendinosis), which is an example of too much activity without appropriate rest. Our body’s ability to repair itself slows with age. Another cause of knee pain relates to changes in the cartilage connecting the patella, or kneecap, at the front of the knee. It functions as a shock absorber, but as we age the cartilage absorbs more water, which decreases its ability to absorb shocks. 

Critical factors

Critical factors in assessing arthritis of the knee are vertical alignment of the knee, range of motion, cartilage wear, and stability. Options for managing arthritis include over-the-counter pain medicines, activity modification, physical therapy (especially to increase the strength of the core muscles: abdomen, back, and pelvis), assistive devices (canes are valuable), and weight loss if the patient’s body mass index, or BMI, is high. 

Knee surgery may be appropriate once pain limits daily activities or occurs at rest, or there is chronic knee swelling, knee deformity, a loss of motion that restricts stair climbing, or a failure to improve substantially with other treatments. Hip replacements are less painful. People are on crutches for a while, and then their hips feel nearly normal. 

Arendt said patients generally find great improvement after surgery but don’t regain their youth and should avoid high impact activities. There are emerging theories in regenerative medicine with clinical trials attempting to stimulate the body’s own repair processes.

UMRA members attending the webinar asked about the relationship between back and knee pain. Arendt said that if the knee problem is due to a deformity in the knee structure, or if a patient limps due to pain, that can throw the back off and cause problems. Her answers to other questions often emphasized preventive steps such as strengthening core and other muscles, using a cane, allowing time to recover from exercise, and managing pain. “Fitness and strengthening, and a heavy dose of common sense,” she said. In short, listen to your body. 

Our webinar Q&A moderator Mary Jo Kane (sport sociology professor emerita and director emerita of the Tucker Center for Research on Girls & Women in Sport), noted that, in addition to improving the knees of multiple UMRA members, Dr. Arendt was a pioneer athletic trainer for women in collegiate sports. She served as medical director for intercollegiate athletics for 25 years, helped to identify why women athletes had more ACL injuries than men and to develop prevention strategies and solutions. We are fortunate to have her at the University.

—Julie Sweitzer, UMRA president-elect